Advanced Meniere Research Articles

Triple Semicircular Canal Plugging versus Labyrinthectomy for Meniere Disease: A Retrospective Study.

The study goals were to compare the long-term efficacy of semicircular canal plugging (SCP) with labyrinthectomy in the treatment of advanced Meniere's disease (MD). A retrospective study. Single tertiary medical center. A total of 116 MD patients (TSCP group of 90; labyrinthectomy group of 26) with complete medical documents in Shandong Provincial ENT Hospital, from March 2017 to March 2019 were retrospectively analyzed, including a battery of auditory and vestibular function tests, recovery time from imbalance and function level scores (FLS). The total control rate of vertigo in the TSCP group was 96.7% (87/90). The rate of hearing loss was 23.3% (21/90). The control rate of vertigo in the labyrinthectomy group was 100% (26/26). All patients lost their auditory function after labyrinthectomy with a 100% hearing loss rate. There was no significant difference in the vertigo control rate between the two groups (P > 0.05). The hearing loss rate in the TSCP group was significantly lower than that in the labyrinthectomy group (P < 0.00). The median time recovered from imbalance was 15 days in TSCP group and 21 days in labyrinthectomy group, which is significantly different (P < 0.05). There was no significant difference in the FLS between the two groups (P > 0.05). Compared to labyrinthectomy, TSCP can preserve hearing at a high probability; meanwhile, otolith organ function preservation benefits patients from faster vestibular compensation. 3 Laryngoscope, 133:3178-3184, 2023.

Simultaneous triple semicircular canal plugging and cochlear implantation in advanced Meniere's disease

Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006), from Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions: A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.

A patient with advanced Meniere's disease cured by aerobic exercise

A patient with advanced Meniere's disease cured by aerobic exercise

Schwannoma in the vestibule and cochlea

Schwannoma of the vestibule or the cochlea is an unusual lesion. In the past, most examples have been found at autopsy or as unsuspected findings at surgery for vertigo. The symptoms of isolated labyrinthine schwannoma may be indistinguishable from advanced Meniere's disease. Magnetic resonance imaging has led to pre-operative diagnosis in some cases. Two cases of schwannoma within the labyrinth from a series of 339 symptomatic acoustic tumours, are presented and the imaging findings are discussed.

Ablation of vestibular function with intramuscular streptomycin

In 1948 Fowler'' reported on four patients with Meniere's disease treated with daily dosages of 4 g of intramuscular streptomycin for total doses ranging from 25 to 30 g. All four patients had a reduction of caloric response; however, two patients noted the recurrence of mild vertigo within 5 to 8 months. Van Deinse treated three patients with 2 g of streptomycin per day for 3 to 4 weeks until the point of labyrinthine inexcitabiIity and repor~ed that two of the patients had no further attacks of vertigo after 4-month periods of observation. Hansen treated five patients with unilateral Meniere's disease who received 2 g of streptomycin per day for 3 to 5 weeks until there was no caloric response in the diseased ear. He noted that vestibular function was lost in the diseased ear sooner than in the normal ear and that three of his patients had improved hearing from the treatment. His patients were observed for 1V2 to 4 years. All patients were improved in that they experienced the cessation of incapacitating attacks of vertigo and returned to work. Ruedis treated three patients with dosages of 2 to 3 g per day for shorter time periods (4 to 20 days). His objective was to preserve some response to caloric testing and/or reduce the severity of ataxia during and after treatment. There was a recurrence of vertigo in one of his patients, re~uiring a second course of treatment. Hamberger et al treated four patients with 3 g per day for a total of 55 to 90 g. The resulting ataxia subsided in 1 to 4 months, and for. the duration of observation there was no further vertigo. Gunther? reported the effective abolition of vertigo after a 3-month follow-up study on eight patients handicapped by advanced Meniere's disease. The hearing was unchanged or improved in the entire group. [atho reported a lO-year study on two patients with Meniere's disease treated with intramuscular streptomycin sulfate. Neither had recurrence of vertigo or change in hearing.

Cochleostomy or Endolymphatic Sac Surgery for Advanced Meniere’s Disease

The operation of cochleostomy is described. The surgical technique is vital for the true assessment of results. If the cochlear duct is punctured, the risk to hearing is unacceptably high. If only the osseous spiral lamina is punctured, the results are acceptable in the short term, though the rationale cannot be explained. In the management of difficult patients with more advanced Meniere's disease, some variant of cochleostomy should probably be included in the therapeutic options. The results of endolymphatic sac surgery are significantly better in a matched group of patients.

Pathogenesis of Meniere's disease and Meniere's syndrome.

Meniere's disease can only be studied in patients, since it does not occur spontaneously in animals nor can it be induced in them. However, aspects of the disease such as endolymphatic hydrops can be usefully studied in animals. A study of the natural history (epidemiology) of Meniere's disease demonstrated the three major symptoms (triad) to be vestibular symptoms, auditory symptoms, and aural pressure. Bilaterality occurs in at least one out of 3 patients, and may approach 50% over full lifespans. Aural pressure (74.1%) was common, as was positional vertigo (85.9%) during and/or between attacks. Clinical variants such as vestibular Meniere's disease could persist for 25 years or more. Understanding the pathogenesis of Meniere's requires a study of known and unknown causes. In this study, Meniere's disease (cause unknown) was differentiated from Meniere's syndrome (cause known). Meniere's disease or syndrome can occur years after some inciting cause; thus all forms of Meniere's can be considered to have a delayed onset. Meniere's syndrome can occur as a sequel to syphilis, otosclerosis, infection (for example otitis media), or trauma. Endolymphatic hydrops explained on the basis of quantity and quality of endolymph is found in all forms of Meniere's disease and syndrome. Representative cases and pathological examples are discussed. Hydrops of the pars inferior (cochlear duct and saccule) is the most important finding in Meniere's disease. In some (but not most) cases, ruptures of the membranes are seen. The saccule can distend into the lateral semicircular canal. Symptomatic attacks are explained on the basis of both physical and biochemical phenomena. This study discusses concepts of pathogenesis of the disease, finding both theories of longitudinal (slow) and radial (fast) flow to be operational. Longitudinal flow, however, appears to be more important than radial flow, especially in advanced Meniere's where perilymph in the scala vestibuli and vestibule disappears and is replaced by membranous labyrinth. Meniere's disease (idiopathic) and Meniere's syndrome (cause known) probably occur as a result of endolymphatic absorptive dysfunction (the site being endolymphatic duct and sac). Hypocellularity of the mastoid and periaqueductal air cells, hypodevelopment of Trautmann's triangle, and anterior displacement of the lateral sinus are likely to be important findings associated with developmentally dysfunctional absorption of endolymph.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical Usefulness of Electrocochleography in Meniere’s Disease: An Analysis of Dehydrating Agents

Both electrocochleography and glycerol dehydration have an important diagnostic and prognostic role in the management of patients with endolymphatic hydrops, whether idiopathic as in Meniere's disease or secondary to certain diseases of the otic capsule. Abnormal electrocochleographic responses in a "normal" ear can be used to predict when Meniere's disease will become bilateral. There is a significant correlation between the effects of glycerol and of endolymphatic sac surgery on the pars inferior, at least over the span of several years. The subject hearing gains, the objective improvements in electrocochleographic responses, and the objective evidence of diminished inner ear impedance, all following proven glycerol dehydration, indicate that even in fairly advanced Meniere's disease, but especially in the earlier stages, reversibility is possible. This is a tantalizing therapeutic challenge.

The cochlear nerve in Meniere's disease.

Cochlear nerves of 11 patients with advanced Meniere's disease were studied by light and electron microscopy. All the nerves appeared normal on light microscopy. In cross sections, the density of myelinated nerve fibers was approximately 20,000 fibers per square millimeter in most cases. In two cases, the density was reduced, about 14,000/sq mm. No correlation was found between the age of patients or the duration of the disease and the density of myelinated nerve fibers. On electron microscopy, there were several features that suggested primary axonal degeneration or segmental demyelination in the cochlear nerve.

Vestibular sensory epithelium in Meniere's disease.

Utricle and horizontal semicircular canal ampulla removed during labyrinthectomy from 11 patients with advanced Meniere's disease were studied under light and electron microscope. In light microscopy the epithelium of both sensory areas appeared fairly normal. Many sensory cells revealed fluid-filled crescents at the nucleus and many cells were extensively vacuolated. Ultrastructurally, a part of the observations were apparently artifacts due to specimen handling; some were normal, age-related findings. Some changes were considered secondary to dilation of the endolymphatic space. True signs of degeneration, seldom seen in these specimens were intraepithelial cysts, necrotic cells, and dark homogeneous masses in the sensory epithelium and dilated nerve fibers in the subepithelial tissue. No general degeneration of the utricular macula or ampullar crista seems to occur in Meniere's disease.

Glycerol test in Ménière's disease.

Ingestion of glycerol, 1.5 g/kg body weight, causes a transient reduction of the hearing loss in the early stage of Meniere's disease. In advanced Meniere eases with mainly flat loss the glycerol e...